=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841664497
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THE JUDGE GROUP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/19/2015
-----------------------------------------------------
Last Update Date | 11/23/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 300 CONSHOHOCKEN STATE RD SUITE 300
-----------------------------------------------------
City | CONSHOHOCKEN
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19428-3801
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-667-7700
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 300 CONSHOHOCKEN STATE RD SUITE 300
-----------------------------------------------------
City | CONSHOHOCKEN
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19428-3801
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-667-7700
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | MR. DOUGLAS SMITH
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 610-617-1442
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | RN253328
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------